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VAERS ID: 1830197

AGE: 14| SEX: M|State: FR

Description

feeling faint; breathless; Palpitations; This is a spontaneous report from a contactable consumer. This is a report received from the regulatory authority. Regulatory authority report number GB-MHRA-WEBCOVID-202110170825392900-KQSJO, Safety Report Unique Identifier GB-MHRA-ADR 26085258. A 14-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: FF828), via an unspecified route of administration on 15Oct2021 (at the age of 14 years old) as dose 1, single for COVID-19 immunisation. The patient's medical history included peanut and sesame allergy. Patient has not had symptoms associated with COVID-19. Concomitant medications were not reported. The patient previously took epinephrine (EPIPEN). The patient experienced feeling faint and breathless on an unspecified date. He had 4 occurrences and one so severe for which he visited ER for electrocardiogram (ECG) trace. The patient experienced palpitations on 15Oct2021. The events were medically significant. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. Outcome of the palpitations was not recovered while of the remaining events was unknown. No follow-up attempts are needed. No further information is expected.

Symptoms

Dizziness, Dyspnoea, Electrocardiogram, Palpitations, SARS-CoV-2 test

Vaccines

VAX DATE: 14 October 2021 | ONSET DATE: 14 October 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • FF828

RECVDATE:28 October 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:Test Name: ecg; Result Unstructured Data: Test Result:unknown results; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Food allergy (Peanut and sesame allergy)
PRIOR_VAX:
SPLTTYPE:GBPFIZER INC202101401072
FORM_VERS:2
TODAYS_DATE:28 October 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:
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